Estate Tax Form 22 Revised 7/03 Date Estate Tax Return and/or this Form Filed in Probate Court Estate Tax Division 1 (800) 977-7711 www.ohio.gov/tax Certificate of Estate Tax Payment and Real Property Disclosure for Dates of Death on or after November 8, 1990 This form should not be sent to the Estate Tax Division in Columbus. Estate of: Decedent’s last name County of residence Decedent’s first name and initial Case number Date of death Part I – Please complete either Section A or B, whichever is applicable. A. This section is to be completed by the estate representative where an Ohio Estate Tax Return is required to be filed. Date of death (please check one): B. This section is to be completed by the estate representative where no Ohio Estate Tax Return is required to be filed. COURT Date of death (please check one): COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. On or after January 1, 2002 – under $338,333 On or after January 1, 2002 – over $338,333 : On or after January 1, 2001 through December 31, 2001 – over $200,000 Calendar No. : On or Plaintiff(s) after January 1, 2001 through December 31, JUDICIAL SUBPOENA -against-2001 – under $200,000 : On or after June 30, 1983 through December 31, 2000 – over $25,000. : On or after June 30, 1983 through December 31, : 2000 – under $25,000. Defendant(s) : . ..... .. .. ... ........ .... ....... . 1. The estate tax return due for this estate was . filed. .in . . . . . . . . . 1.. .No. estate. tax. return. .is. .required to be filed because the gross estate, which includes all real property, falls beprobate court on the date stamped hereon. low NEW YORK THE PEOPLE OF THE STATE OFthe filing requirements set forth in O.R.C. Section 2. All estate taxes shown due, if any, on the return have 5731.21(A)(3). been paid in full. (This step will take effect upon TO verifica2. All real property listed in the attached inventory for the tion by the County Auditor on page 3, Part II of this form.) decedent’s estate, as well as the following real property GREETINGS: 3. All real property listed in the inventory for the decedent’s not listed in the inventory and attached to this certifiWE all business and excuses being laid aside, estate is included in the estate tax return as well as the COMMAND YOU, that shall be free of any lien you and each of you attend before cate, for estate taxes under , the Honorable at the Court following real property not listed in the inventory andof located at County atO.R.C. Sections 5731.02 and 5731.19(A). in room , on the day of , 20 , at o'clock in the noon, and at any recessed tached to this certificate. or adjourned date, to testify and give evidence as a witness in this action on the part of the 4. The real property attached to this certificate shall be free of any lien for estate taxes under O.R.C. Sections failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Your 5731.02 and 5731.19(A). This certificate does the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a not take result of your failure to comply. effect until verification of payment of tax is received from Witness, Honorable , one of the Justices of the the County Auditor’s office. This certificate does not reCourt in County, day of , 20 flect the Tax Commissioner’s final determination of estate tax under O.R.C. Section 5731.26. (Attorney must sign above and type name below) Declaration Attorney(s) for The information contained on this certificate, to the best of my knowledge, is true and complete. Office and P.O. Address Name of estate representative Signature of estate representative Address of estate representative Telephone No.: Facsimile No.: E-Mail Address: Date Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Instructions for Completion : Calendar No. Estate Representative If an estate tax return is required to be filed. Plaintiff(s) : Estate Tax Form 22 Revised 7/03 Page 2 JUDICIAL SUBPOENA The -against-estate representative completes Section A in Parts I and II of this certificate. The : estate representative is required to sign Part I of the certificate. For dates of death on or after November 8, 1990, this certificate is required to accompany one of the following : returns when it is filed with the probate court: (a) Resident Ohio Estate Tax Return (Estate Tax Form 2) : (b) Nontaxable Return (Estate Tax Form 2) (c) Ohio Nonresident Estate Tax Return (Estate Tax Form 4) Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(d) . Amended Resident .Ohio.Estate Tax Return (Estate Tax Form 2-X) .. ............... ... .. The estate representative completes Section B in Part I only. The estate representative If no estate tax return is required to sign Part I of this certificate. is required to be filed. THE PEOPLE OF THE STATE OF NEW YORK TO Probate Court If an estate tax return is required to be filed. GREETINGS: Upon receipt of one of the above-listed returns for filing, the probate court date stamps both the return and Part I of this certificate. Part I is maintained in the court’s public record file. Part II of this certificate is forwarded to that all business with the filed return or Estate Tax Form each of you attend before WE COMMAND YOU,the county auditor and excuses being laid aside, you and5 for verification of payment of tax. , the Honorable at the Court located at County of After receipt of Part II of this certificate from the county auditor, the probate court signs in room , on the day of , 20 , at o'clock in the noon, and at any recessed and date stamps Section C. Part II is then filed with Part I in the public record file. or adjourned date, to testify and give evidence as a witness in this action on the part of the If no estate tax return The probate court date stamps Part I of this certificate. Part I is then maintained in the probate court’s public record file. Part II is not applicable. is required to be filed. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a County Auditor result of your failure to comply. If the estate taxes have been paid in full, the county auditor completes Section B of If an estate tax return is Witness, Honorable Part II of this certificate to verify that the taxes have been paid in full. of the , one of the Justices The county auditor required to be filed. Court in County, validates of date the return was filed. Part II of this certificate is maintained at the day the , 20 county auditor’s office until all taxes shown to be due have been paid. When the taxes are paid, the county auditor signs and date stamps Part II. After completion, Part II is returned to the probate court. This same procedure is followed for nontaxable filings. (Attorney must sign above and type name below) If no estate tax return is required to be filed. Neither Part I nor Part II of this certificate shall be forwarded to the county auditor’s office. Attorney(s) for Property Description If an estate tax return is required to be filed. Attach all real property not listed in the inventory including permanent parcel number, Office and P.O. Address address and full legal description. If no estate tax return is required to be filed. Attach a copy of the inventory for the decedent’s estate as well as all real property not listed on the inventory, including Telephone No.: number, address and full legal depermanent parcel Facsimile No.: scription. E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. Certificate of Estate Tax Payment and Real Property Disclosure : Calendar No. for Dates of Death on or After November 8, 1990 (O.R.C. Section 5731.21) : Plaintiff(s) Part II -against- Estate Tax Form 22 Revised 7/03 Page 3 JUDICIAL SUBPOENA : : A. This section is to be completed by the Estate Representative. : Defendant(s) Estate of : ...................................................... Date of death Case number County THE PEOPLE OF THE STATE OF NEW YORK B. TO This section is to be completed by the County Auditor. I hereby verify that the estate taxes shown due on the estate tax return filed on GREETINGS:paid in full. have been Date Tax Paid to WE COMMAND YOU, that all business and excuses being laid aside, you and each ofAuditor you attend before County , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed County to testify or adjourned date,Auditor and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to By: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Deputy result of your failure to comply. Witness, Honorable Court in County, C. , one of the Justices of the day of , 20 This section is to be completed by the Probate Judge. (Attorney must sign above and type the date The verification of this certificate by the County Auditor was filed in this court onname below) stamped hereon. Attorney(s) for Date Filed in Probate Court Probate Judge Office and P.O. Address By: Deputy Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Instructions for Completion : Calendar No. Estate Representative If an estate tax return is required to be filed. Plaintiff(s) : Estate Tax Form 22 Revised 7/03 Page 4 JUDICIAL SUBPOENA The -against-estate representative completes Section A in Parts I and II of this certificate. The : estate representative is required to sign Part I of the certificate. For dates of death on or after November 8, 1990, this certificate is required to accompany one of the following : returns when it is filed with the probate court: (a) Resident Ohio Estate Tax Return (Estate Tax Form 2) : (b) Nontaxable Return (Estate Tax Form 2) (c) Ohio Nonresident Estate Tax Return (Estate Tax Form 4) Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(d) . Amended Resident .Ohio.Estate Tax Return (Estate Tax Form 2-X) .. ............... ... .. The estate representative completes Section B in Part I only. The estate representative If no estate tax return is required to sign Part I of this certificate. is required to be filed. THE PEOPLE OF THE STATE OF NEW YORK TO Probate Court If an estate tax return is required to be filed. GREETINGS: Upon receipt of one of the above-listed returns for filing, the probate court date stamps both the return and Part I of this certificate. Part I is maintained in the court’s public record file. Part II of this certificate is forwarded to that all business with the filed return or Estate Tax Form each of you attend before WE COMMAND YOU,the county auditor and excuses being laid aside, you and5 for verification of payment of tax. , the Honorable at the Court located at County of After receipt of Part II of this certificate from the county auditor, the probate court signs in room , on the day of , 20 at o'clock with and date stamps Section C., Part II is then filedin thePart I noon, and at record file. in the public any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the If no estate tax return is required to be filed. The probate court date stamps Part I of this certificate. Part I is then maintained in the probate court’s public record file. Part II is not applicable. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a County Auditor result of your failure to comply. If the estate taxes have been paid in full, the county auditor completes Section B of If an estate tax return is Witness, Honorable Part II of this certificate to verify that the taxes have been paid in full. of the , one of the Justices The county auditor required to be filed. Court in County, validates of date the return was filed. Part II of this certificate is maintained at the day the , 20 county auditor’s office until all taxes shown to be due have been paid. When the taxes are paid, the county auditor signs and date stamps Part II. After completion, Part II is returned to the probate court. This same procedure is followed for nontaxable filings. (Attorney must sign above and type name below) If no estate tax return is required to be filed. Neither Part I nor Part II of this certificate shall be forwarded to the county auditor’s office. Attorney(s) for Property Description If an estate tax return is required to be filed. Attach all real property not listed in the inventory including permanent parcel number, address and full legal description.Office and P.O. Address If no estate tax return is required to be filed. Attach a copy of the inventory for the decedent’s estate as well as all real property not listed on the inventory, including Telephone No.: number, address and full legal depermanent parcel Facsimile No.: scription. E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com